BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA DECISION

Transcription

1 BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA In the Matter of the Accusation ) Against: ) ) ) Chitra Anjani Bhakta, M.D. ) ) Physician's and Surgeon's ) Certificate No. A ) ) Respondent ) File No DECISION The attached Stipulated Settlement and Disciplinary Order is hereby adopted as the Decision and Order of the Medical Board of California, Department of Consumer Affairs, State of California. This Decision shall become effective at 5:00 p.m. on October 29, IT IS SO ORDERED September 29, MEDICAL BOARD OF CALIFORNIA By:~~ Ja~ Panel A Esq., Chair

2 KAMALA D. HARRIS Attorney General of California Juorn-1 T. ALVARADO Supervising Deputy Attorney General CLAUDIA RAMIREZ Deputy Attorney General State Bar No California Department of Justice 300 South Spring Street, Suite 1702 Los Angeles, California Telephone: (213) Facsimile: (213) Attorneysfor Complainant BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA 11 In the Matter of the Accusation Against: Case No CHITRA BHAKTA, M.D. 22 Belcanto 13 Irvine, California Physician's and Surgeon's Certificate No. A 63631, OAH No STIPULATED SETTLEMENT AND DISCIPLINARY ORDER 16 Respondent IT IS HEREBY STIPULATED AND AGREED by and between the parties to the above- 19 entitled proceedings that the fo!lowing matters are true:. 20 PARTIES 21 I. Kimberly Kirchmeyer ("Complainant") is the Executive Director of the Medical 22 Board of California ("Board''). She brought this action solely in her official capacity and is 23 represented in this matter by Kamala D. Harris, Attorney General of the State of California, by 2 Claudia Ramirez, Deputy Attorney General Respondent Chitra Bhakta, M.D. ("Respondent") is represented in this proceeding by attorney John D. Harwell, Esq., whose address is: th Street, Manhattan Beach, California On or about October I 0, 1997, the Board issued Physician's and Surgeon's Certificate Stipulated Settlement (Case No )

3 No. A to Respondent. That Certificate was in full force and effect at all times relevant to 2 the charges brought in Accusation No and will expire on March 31, 2017, 3 unless renewed. JURISDICTION 5. Accusation No was filed before the Board, and is currently pending 6 against Respondent. The Accusation and all other statutorily required documents were properly 7 served on Respondent on January 13, Respondent timely filed her Notice of Defense 8 contesting the Accusation A copy of Accusation No is attached as Exhibit A and incorporated l O herein by reference. 11 ADVISEMENT AND WAIVERS Respondent has carefully read, fully discussed with counsel, and understands the 13 charges and allegations in Accusation No Respondent has also carefully read, 1 fully discussed with counsel, and understands the effects of this Stipulated Settlement and 15 Disciplinary Order Respondent is fully aware of her legal rights in this matter, including the right to a 17 hearing on the charges and allegations in the Accusation; the right to be represented by counsel at 18 her own expense; the right to confront and cross-examine the witnesses against her; the right to 19 present evidence and to testify on her own behalf; the right to the issuance of subpoenas to 20 compel the attendance of witnesses and the production of documents; the right to reconsideration 21 and court review of an adverse decision; and all other rights accorded by the California 22 Administrative Procedure Act and other applicable laws Respondent voluntarily, knowingly, and intelligently waives and gives up each and 2 every right set forth above. 25 CULP ABILITY 9. Respondent does not contest that, at an administrative hearing, Complainant could 27 establish a prima facie case with respect to the charges and allegations contained in Accusation 28 No , and that she has thereby subjected her license to disciplinary action. 2 Stipulated Settlement (Case No )

4 1 1 O. Respondent agrees that her Physician's and Surgeon's Certificate is subject to 2 discipline and she agrees to be bound by the Board's imposition of discipline as set forth in the 3 Disciplinary Order below. 11. The admissions made by Respondent herein are only for the purposes of this 5 proceeding, or any other proceedings in which the Board or other professional licensing agency is 6 involved, and shall not be admissible in any other criminal, civil or other proceeding. 7 CONTINGENCY This stipulation shall be subject to approval by the Board. Respondent understands 9 and agrees that counsel for Complainant and the staff of the Board may communicate directly 1 o with the Board regarding this stipulation and settlement, without notice to or participation by 11 Respondent or her counsel. By signing the stipulation, Respondent understands and agrees that 12 she may not withdraw her agreement or seek to rescind the stipulation prior to the time the Board 13 considers and acts upon it. If the Board fails to adopt this stipulation as its Decision and Order, 1 the Stipulated Settlement and Disciplinary Order shall be of no force or effect, except for this 15 paragraph, it shall be inadmissible in any legal action between the parties, and the Board shall not 16 be disqualified from further action by having considered this matter The parties understand and agree that Port?,ble Document Format (PDF) and facsimile 18 copies of this Stipulated Settlement and Disciplinary Order, including Portable Document Format 19 (PDF) and facsimile signatures thereto, shall have the same force and effect as the originals In consideration of the foregoing admissions and stipulations, the parties agree that 21 the Board may, without further notice or formal proceeding, issue and enter the following 22 Disciplinary Order: 23 DISCIPLINARY ORDER 2 A. PUBLIC REPRIMAND 25 IT IS HEREBY ORDERED THAT Physician's and Surgeon's Certificate No. A issued to Respondent Chitra Bhakta, M.D., shall be and is hereby publicly reprimanded pursuant 27 to California Business and Professions Code section 2227, subdivision (a)(). This public 28 reprimand, which is issued in connection with Respondent's care and treatment of Patient C.H. as 3 Stipulated Settlement (Case No )

5 set forth in Accusation No , is as follows: 2 'Between May 2012 to December 2012, you committed acts constituting gross negligence 3 and repeated negligent acts in violation of Business and Professions Code section 223, subdivisions (b) and (c), respectively, in that you allowed Patient C.H. to mix and self administer 5 intravenous antibiotics and you inadequately monitored the antibiotic treatment, as more fully 6 described in Accusation You also maintained inadequate medical records in violation of Business and Professions 8 Code section 26 in that Patient C.H.'s records show that you failed to communicate with home 9 nursing staff and/or Patient C.H. on a regular basis as to her status, as more fully described in 1 O Accusation " 11 B. PRESCRIBING PRACTICES COURSE 12 Within sixty (60) calendar days of the effective date of this Decision, Respondent shall 13 enroll, at her own expense, in a course in prescribing practices, approved in advance by the Board \ or its designee. The PACE prescribing course offered at the University of California - San Diego 15 School of Medicine is an approved course. Respondent shall successfully complete said course \6 no later than six months after her initial enrollment unless the Board or its designee agrees in 17 writing to a later time for completion. Respondent may satisfy this term by successfully 18 completing said course prior to the effective date of the Decision adopting this Stipulated 19 Settlement. Upon successfully completing said course, Respondent agrees to forward, no later 20 than 15 days after successfully completing the course, a copy of the Certificate of Successful 21 Completion of the course to the Board or its designee. 22 Failure to participate in and successfully complete the prescribing practices course outlined 23 above shall constitute unprofessional conduct and is grounds for further disciplinary action. 2 C. MEDICAL RECORD-KEEPING COURSE 25 Within sixty (60) calendar days of the effective date of this Decision, Respondent shall enroll, at her own expense, in a course in medical record keeping, approved in advance by the 27 Board or its designee. The PACE medical record keeping course offered at the University of 28 California - San Diego School of Medicine is an approved course. Respondent shall successfully Stipulated Settlement (Case No )

6 complete said course no later than six months after her initial enrollment unless the Board or its 2 designee agrees in writing to a later time for completion. Respondent may satisfy this term by 3 successfully completing said course prior to the effective date of the Decision adopting this Stipulated Settlement. Upon successfully completing said course, Respondent agrees to forward, 5 no later than 15 days after successfully completing the course, a copy of the Certificate of 6 Successful Completion of the course to the Board or its designee. 7 Failure to participate in and successfully complete the medical record-keeping course 8 outlined above shall constitute unprofessional conduct and is grounds for further disciplinary 9 action. 10 D. EDUCATION COURSE 11 Within 60 calendar days of the effective date of this Decision, Respondent shall submit to 12 the Board or its designee for its prior approval educational program(s) or course(s) which shall 13 not be less than 20 hours. The educational program(s) or course(s) shall be aimed at correcting 1 any areas of deficient practice or knowledge and shall be Category I certified, Jim ited to 15 classroom, conference, or seminar settings. The educational program(s) or course(s) shall be at 16 Respondent's expense and shall be in addition to the Continuing Medical Education ("CME") 17 requirements for renewal of licensure. The prescribing practices course and the medical record- 18 keeping course listed above shall not satisfy this condition. 19 Respondent shall provide proof of attendance for 20 hours of CME in satisfaction of this 20 condition, proof of which shall be provided within 180 calendar days of the effective date of this 21 Decision. 22 Failure to participate in and successfully complete the education course outlined above shall 23 constitute unprofessional conduct and is grounds for further disciplinary action. 2 ACCEPTANCE 25 I have carefully read the above Stipulated Settlement and Disciplinary Order and have fully discussed it with my attorney, John D. Harwell, Esq. I understand the stipulation and the effect it 27 will have on my Physician's and Surgeon's Certificate. I enter into this Stipulated Settlement and 28 Disciplinary Order voluntarily, knowingly, and intelligently, and agree to be bound by the 5 Stipulated Settlement (Case No )

7 Decision and Order of the Medical Board of California. 2 3 DATED 6?~i:~ -- CHITRA BHAKTA, M.D. Respondent 5 I hsve read and fully discussed with Respondent Chitra Bhakta, MD. the terms and 6 conditions and other matters contained in the above Stipulated Settlement and Disciplinary Order. 7 l approve its form and content. 8 r.lts 9 DATED P,,/:z.. lo ENDORSEMENT 13 The foregomg Stipulated Settlement and Disciplinary Order is hereby respectfully 1 submitted for consideration by the Medical Board of California.! Dated: LA20l6l doc i-;;r7 - l5 Respectfully submitted, KAMALA D. HARRIS r;;;;;;;rir:;ey Attorney General of California ~eneral JUDIT1-I T. ALVARADO CLAUDIA RAW~ Deputy Attorney General Attorneysfor Conplainant Vtfd... U Stipulated Settlement (Ca,e No )

8 Exhibit A Accusation No

9 KAMALA D. HARRIS Attorney General of California ROBERT MCKIM BELL Supervising Deputy Attorney General RANDALL R. MURPHY Deputy Attorney General State Bar No California Department of Justice 300 South Spring Street, Suite 1702 Los Angeles, California Telephone: (213) Facsimile: (213) Attorneys.for Complainant FILED STATE OF CALIFORNIA MEDICAL BOARD OF CALIFORNIA SACRAMENT03=Y\~,,~ '::i 20,s BY '\L s. ANALYST BEFORE THE MEDICAL BOARD OF CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS STATE OF CALIFORNIA 11 In the Matter of the Accusation Against: Case No CHITRA BHAKTA, M.D. 22 Belcanto, Irvine, California 91 Physician's and Surgeon's Certificate No. A 63631, Respondent. ACCUSATION 19 Complainant alleges: 20 PARTIES Kimberly Kirchmeyer (Complainant) brings this Accusation solely in her official 22 capacity as the Executive Director of the Medical Board of California ("Board") On October 10, 1997, the Board issued Physician's and Surgeon's Certificate number A to Chitra Bhakta, M.D. ("Respondent"). That license was in full force and effect at all times relevant to the charges brought herein and will expire on March 31, 2015, unless renewed. I I I I I I 1 Accusation

10 JURISDICTION 2 3. This Accusation is brought before the Board under the authority of the following 3 laws. All section references are to the Business and Professions Code ("Code") unless otherwise indicated. 5. The Medical Practice Act ("Act") is codified at sections of the Business 6 and Professions Code Pursuant to Code section , the Board's highest priority is public protection Code section 2227, subdivision (a), provides as follows: 9 "(a) A licensee whose matter has been heard by an administrative law judge of the Medical Quality Hearing Panel as designated in Section of the 10 Government Code, or whose default has been entered, and who is found guilty, or who has entered into a stipulation for disciplinary action with the board, may, in 11 accordance with the provisions of this chapter: 12 "( 1) Have his or her license revoked upon order of the board. 13 "(2) Have his or her right to practice suspended for a period not to exceed one year upon order of the board. 1 "(3) Be placed on probation and be required to pay the costs of probation 15 monitoring upon order of the board. 16 "( ) Be publicly reprimanded by the board. The public reprimand may include a requirement that the licensee complete relevant educational courses 1 7 approved by the board. 18 "(5) Have any other action taken in relation to discipline as part of an order of probation, as the board or an administrative law judge may deem proper. 19 "(b) Any matter heard pursuant to subdivision (a), except for warning 20 letters, medical review or advisory conferences, professional competency examinations, continuing education activities, and cost reimbursement associated 21 therewith that are agreed to with the board and successfully completed by the licensee, or other matters made confidential or privileged by existing law, is deemed 22 public, and shall be made available to the public by the board pursuant to Section " Section 223 of the Code, states: 2 "The board shall take action against any licensee who is charged with unprofessional 25 conduct. In addition to other provisions of this article, unprofessional conduct includes, but is not limited to, the following: "(a) Violating or attempting to violate, directly or indirectly, assisting in or abetting 27 the violation of, or conspiring to violate any provision of this chapter. 28 "(b) Gross negligence. 2 Accusation

11 "( c) Repeated negligent acts. To be repeated, there must be two or more negligent acts or omissions. An initial negligent act or omission followed by a separate and distinct departure from the applicable standard of care shall constitute repeated negligent acts. "( 1) An initial negligent diagnosis followed by an act or omission medically appropriate for that negligent diagnosis of the patient shall constitute a single negligent act. "(2) When the standard of care requires a change in the diagnosis, act, or omission that constitutes the negligent act described in paragraph (1 ), including, but not limited to, a reevaluation of the diagnosis or a change in treatment, and the licensee's conduct departs from the applicable standard of care, each departure constitutes a separate and distinct breach of the standard of care. "(d) Incompetence. "( e) The commission of any act involving dishonesty or corruption which is substantially related to the qualifications, functions, or duties of a physician and surgeon. "(f) Any action or conduct which would have warranted the denial of a certificate. "(g) The practice of medicine from this state into another state or country without meeting the legal requirements of that state or country for the practice of medicine. Section 231 shall not apply to this subdivision. This subdivision shall become operative upon the implementation of the proposed registration program described in Section "(h) The repeated failure by a certificate holder, in the absence of good cause, to attend and participate in an interview scheduled by the mutual agreement of the certificate holder and the board. This subdivision shall only apply to a certificate holder who is the subject of an investigation by the board." FACTS ALLEGED 8. C.H. is a wheelchair dependent patient. Respondent first saw C.H. on May 22, On C.H.'s first appointment, Respondent took an in-depth history with regards to C.H. 'scare with over 15 doctors, a hospitalization for severe pain and a complete medical work up. 9. C.H. told Respondent that she had been bitten by a tick while working outside after which she suffered from the target rash and joint pain that is typical of Lyme Disease. 10. Respondent had C.H. sign a consent for treatment and another consent for treatment for Intravenous antibiotics on May 22, The records show that C.H. was advised that the use of Intravenous antibiotics had specific risks such as sepsis and that is why Respondent enforced monthly blood draws and monthly appointments while patients remained on intravenous therapy Accusation

12 11. There was no physical examination noted on the initial chart provided by Respondent 2 noting C.H.' s function capability while confined to a wheelchair There was no documentation of a supportive individual present with C.H. and she had stated that she had once been her boyfriend's caretaker prior to falling ill herself. C.H. followed 5 up with Respondent after initial labs had been drawn on June 29, Respondent charted in 6 her notes that C.H was Lymes positive and prescribed intravenous antibiotics for C.H. There are 7 no vital signs charted on the preliminary notes provided nor is there a physical exam charted Respondent informed patient in the consent forms that Lyme Disease is a 9 controversial disease and is largely a clinical diagnosis when the primary test, Western Blot, is 1 O negative. C.H. signed her consent understanding the risks were more severe with IV therapy than 11 oral antibiotic therapy and there was a greater need for accountability and follow up C.H. 's records reflect notes for an August 1, 2012 "follow up." However, this 13 appears to be a "telephone appointment" during where Respondent notified C.H. that her 1 laboratory results came back positive for Lyme Disease.' Respondent asked her staff to the 15 test results and labs to C.H. It appears that prior to the telephone appointment, C.H. had received 16 three weeks of antibiotic therapy and had reported some improvement. C.H. was told to return in 17 a month for her standard monthly laboratory tests and blood tests to be drawn prior to her 18 appointment C.H. returned on September 18, 2012, for her follow up appointment without any 20 labs. There are no vital signs or a physical exam of the wound site noted on the chart. C.H. told 21 Respondent that she could not afford her Invanz antibiotics and she had several other concerns 22 about how she cannot get certain labs drawn or referrals due to cost. As a result, Respondent 23 switched antibiotics but first ordered an abdominal ultrasound to assess if C.H. had a healthy 2 gallbladder A revised note was provided by Respondent, which now has vital signs, and detailed risks and benefits are listed on the new chart note, although no physical exam was charted. 2 Respondent's chart notes stress the importance oflabs and the ultrasound to assure safe care of the patient. However, Respondent wrote the prescription for Rocephin changing the (continued... ) Accusation

13 16. Respondent's staff appears to have asked C.H. if she was working with a registered 2 nurse to help her with weekly wound care and home assessments. However, a registered nurse 3 must provide chart notes to the attending physician who is supervising the patient's care. Thus, such an inquiry would be unnecessary if proper protocols were being followed Respondent's records -- or the lack thereof -- indicate that she and/ or her staff failed 6 to communicate on a regular basis with nursing staff providing home health care monitoring to 7 C.H However, Respondent's re-written chart notes include new charted notes warning 9 C.H. of the consequences for non-compliance. The specific entries were not present in the 1 O original provider notes produced, and call into question when they were actually written In October, 2012, C.H. did not appear for her appointment. She also went an 12 additional month being non-compliant with labs, did not follow up with a neurologist, and did not 13 enroll in physical therapy. Respondent's staff made several attempts to reach C.H. to reschedule. 1 However, Respondent did not discontinue the intravenous antibiotics by calling the infusion 15 center C.H. was responsible for mixing and administering her own home intravenous 17 antibiotics, with no skilled nursing assistance In November, 2012, Respondent's staff reached out to C.H. trying to reach her to 19 come and make an appointment. However, this appears to have occurred only because the 20 infusion center notified Respondent's clinic that they would no longer provide intravenous 21 antibiotics to C.H. due to non-payment. The records for this month indicate that Respondent 22 requested a referral for removal of the Hickman catheter and a request for C.H. to come into the 23 clinic to pick up that removal referral At no time did Respondent take responsibility and attempt to telephone the patient 25 herself to warn her of the risk of sepsis if the Hickman catheter were not removed (... continued) antibiotic regime despite the fact that C.H. never obtained labs and never obtained the abdominal ultrasound. 5 Accusation

14 23. Although C.H. listed her daughter, F., as the emergency contact person, at no time did Respondent's office document that they tried to contact F. 2. Respondent took a detailed history on C.H.'s new patient intake but failed to assure that at least two other people would serve as contact points to ascertain that the patient was safe and capable of self-care. In fact, Respondent failed to determine the name or number of the boyfriend C.H. stated that she lived with as an emergency contact. 25. In December, 2012, C.H. 's sister, K.T., a registered nurse, found C.H. at her home soiled in urine with adult diapers around the room. When discovered, C.H. was unable to even support herself to get in and out of her bed. Furthermore, C.H. had fallen at some point in time and had fractured her hip and not sought medical care.. K.T. eventually took C.H. to St. John's Pleasant Valley Hospital, where the line sepsis was discovered and the Hickman catheter was removed. C.H. was hospitalized for three weeks on intravenous antibiotics as a result. FIRST CAUSE FOR DISCIPLINE (Unprofessional Conduct - Gross Negligence) 27. By reason of the matters set forth above in paragraphs 8 through, incorporated herein by this reference, Respondent is subject to disciplinary action under section 223(b) of the Code, in that she was grossly negligent in the care and treatment of C.H. The circumstances are as follows: 28. Respondent failed to take an appropriate intake history when she chose to allow C.H. to do home IV therapy, which action constitutes gross negligence and is a violation of section 223(b) of the Code. 29. Respondent failed to establish a point of contact and safety for C.H., which actions constitute gross negligence and is a violation of section 223(b) of the Code. 30. Respondent allowed C.H. to mix and administer her own intravenous antibiotics, which actions constitute gross negligence and is a violation of section 223(b) of the Code Accusation

15 1 31. Respondent gave C.H. a new Rocephin medication on September 18, 2012, even though C.H. had failed to obtain an abdominal ultrasound as ordered, which was necessary for Respondent to know if it was safe to use, which action constitutes gross negligence and is a violation of section 223(b) of the Code. SECOND CAUSE FOR DISCIPLINE (Unprofessional Conduct - Repeated Negligent Acts) 32. By reason of the matters set forth above in paragraphs 8 through 31, incorporated herein by this reference, Respondent is subject to disciplinary action under section 223( c) of the Code in that she was repeatedly negligent in the care and treatment of C.H. The circumstances are as follows: 33. Respondent failed to appropriately monitor and survey the safety of C.H.'s home intravenous therapy (IV), which actions constitute negligence and which actions, in conjunction with other acts of negligence, constitute repeated negligent acts and is a violation of section 223( c) of the Code. 3. Respondent failed to cancel the home intravenous antibiotics in September, 2012, when C.H. failed to have her laboratory tests and blood draws done prior to her appointment, or at all, which actions constitute negligence and which actions, in conjunction with other acts of negligence, constitute repeated negligent acts and is a violation of section 223( c) of the Code. 35. Respondent failed to discontinue home Intravenous antibiotics following C.H. 's repeated failures to comply with the signed patient plan, which actions constitute negligence and which actions, in conjunction with other acts of negligence, constitute repeated negligent acts and is a violation of section 223(c) of the Code. THIRD CAUSE FOR DISCIPLINE (Failure to Maintain Adequate and Accurate Records) By reason of the matters set forth above in paragraphs 8 through 35, incorporated 27 herein by this reference, Respondent is subject to disciplinary action under section 26 of the 28 7 Accusation

16 Code, in that she failed to maintain adequate and accurate medical records. The circumstances 2 are as follows: Respondent's records, or the lack thereof, indicate that she and/or her staff failed to communicate on a regular basis with nursing staff providing home health care monitoring to C.H., and/or C.H. herself as to her status. PRAYER WHEREFORE, Complainant requests that a hearing be held on the matters herein alleged, and that following the hearing, the Medical Board of California issue a decision: 1. Revoking or suspending Physician's and Surgeon's Certificate Number A 63631, 11 issued to Chitra Bhakta, M.D Revoking, suspending or denying approval of her authority to supervise physician assistants, pursuant to section 3527 of the Code; 3. Ordering her to pay the Medical Board of California the costs of probation monitoring if placed on probation, and;. Taking such other and further action as deemed necessary and proper DATED: J,~Ia~n~u~a~r~y---L1~3~,,,._20~1~5,L_~- Complainant / 2 LA l doc Accusation